Court acknowledges causal relationship between catastrophic injuries and hyperelipidemia
This month, the Court of Appeals in Scott v. State Farm rejected State Farm's refusal to pay for cholesterol medication on behalf of a severely head-injured young woman. The woman's physicians had confirmed that one cause of her hyperlipidemia was her catastrophic head injury from a motor vehicle accident: it disabled her from exercise and denied her normal mental acuity and judgment.
The medical experts and the court acknowledged that the young woman probably had a genetic predisposition toward hyperlipidemia. Nevertheless, her inability to exercise and her head-injury sequelae, limiting her self control and impulse control, also played a causative factor in her need for medication.
The Court of Appeals noted that causation in the no fault Personal Injury Protection context requires only a low threshold of proof. To recover PIP benefits, an injury victim's causation proof could not be "fortuitous" or "incidental" (sometimes called "but for" causation), but it also need not meet the negligence standard of "proximate" cause. The Court determined that the testimony of the medical experts established the requisite level of proof in the young woman's case.
This holding has wide application to a number of "normal" medical conditions which are exacerbated in the case of severely injured individuals. It is well known that paralysis and severe head injury can significantly complicate the victim's over-all health. Were this not the case, State Farm might not have spent in legal fees and costs several times the lifetime expense of providing a statin to this young lady: but then, who knows? Some adjusters issue denials that are difficult to fathom.